This week I want to share a personal story, to continue the discussion we began last week with the personal story of a woman who went through great suffering after being denied access to opiates.
I found out last week that a former patient of mine had died from a drug overdose. She had been my patient for more than three years, but the last time I saw her was in 2010. While I was seeing her, she was doing well on Suboxone, and talked about how she was able to feel normal, and live her life again, for the first time in a long time. It’s something I often hear from my patients. And just like all my patients, I spent a great deal of time talking to her about the chronic nature of addiction, what her long history of use would mean for her future, and the worry that her brain might be in a permanent state of chemical imbalance. Sometimes this imbalance is acquired with long and heavy drug use, sometimes it is inherited, and oftentimes it is a mixture of both, but in the majority of cases, it can last the patient’s entire life. I told her this routinely, as I tell all my patients, and gave her access to all the resources I have used, and ones I have generated specifically for my patients. In spite of all this, though, she remained obsessed with tapering off her dose of Suboxone and getting off the medication altogether. Everyone in her life had been telling her for years that that was the only way to be truly “clean”.
Eventually, she stopped seeing me, and went into a rehab program that didn’t use maintenance therapy. It seems that experience went well, because afterwards she went on to get certified as an addiction counselor. It was while she was working as an addiction counselor that she relapsed, overdosed, and died.
I hadn’t talked to this patient since she left my practice, so I can’t say what was going on in her life, or what she was thinking at the time of her relapse and overdose. What I can say is what I’ve heard from other patients who have spent time in the worlds of rehab and “professional addiction counseling”; that, in those environments, wanting or trying to stay on a maintenance medication is often seen as “dirty”, humiliating, failure, or “just as bad” as being on heroin or prescription pain pills. I’m not sure that my old patient ever wanted to get back the feelings of normalcy that she had on Suboxone — but even if she did, it probably would have been enormously difficult for her due to her career, and the people who surrounded her. It’s quite common for people who are addicted to surround themselves with support networks, but there are times when such networks can actually do more harm than good.The pressure to show that she “wanted it bad enough” might have been one of many that led to an eventual relapse. It’s a scenario that many of my patients have been in, though with less terrible consequences.
It’s my opinion, often discussed here, that non-maintenance based rehab and “counseling” contains a great deal of poisonous misinformation, sometimes spread maliciously, sometimes not. Either way, once a patient or counselor or both is entangled in the web of the clean/dirty dichotomy and “willpower”, as well as religious programs they may or may not believe in, it can be almost impossible to get out again. It always saddens me to see one of my patients leave a program which I know can give them a stable, healthier life, only to get caught up torturous and convoluted philosophies which might help, but tend to hide their helpful information under heaps of useless suffering and shaming.
Of course, my thoughts are with my former patient’s family and those who were close to her. Even so, this post is a perfect example of our discussion last week, about how tragedies exist on both sides of any debate, and can be used to make any point. Tragedies are not arguments; they are simply tragedies.